Heel Pain

Heel Pain Has Many Causes

In our pursuit of healthy bodies, pain can be an enemy. In
some instances, however, it is of biological benefit. Pain
that occurs right after an injury or early in an illness may
play a protective role, often warning us about the damage
we've suffered.

When we sprain an ankle, for example, the pain warns us
that the ligament and soft tissues may be frayed and bruised,
and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to
seek medical attention. This alert is of utmost importance
because of the many afflictions that contribute to heel
pain.

Heel Pain

Heel pain is generally the result of faulty biomechanics
(walking gait abnormalities) that place too much stress on
the heel bone and the soft tissues that attach to it. The
stress may also result from injury, or a bruise incurred
while walking, running, or jumping on hard surfaces; wearing
poorly constructed footwear; or being overweight.

The heel bone is the largest of the 26 bones in the human
foot, which also has 33 joints and a network of more than 100
tendons, muscles, and ligaments. Like all bones, it is
subject to outside influences that can affect its integrity
and its ability to keep us on our feet. Heel pain, sometimes
disabling, can occur in the front, back, or bottom of the
heel.

Heel Spurs

A common cause of heel pain is the heel spur, a bony
growth on the underside of the heel bone. The spur, visible
by X ray, appears as a protrusion that can extend forward as
much as half an inch. When there is no indication of bone
enlargement, the condition is sometimes referred to as "heel
spur syndrome."

Heel spurs result from strain on the muscles and ligaments
of the foot, by stretching of the long band of tissue that
connects the heel and the ball of the foot, and by repeated
tearing away of the lining or membrane that covers the heel
bone. These conditions may result from biomechanical
imbalance, running or jogging, improperly fitted or
excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently associated
with an inflammation of the band of fibrous connective tissue
(fascia) running along the bottom (plantar surface) of the
foot, from the heel to the ball of the foot. The inflammation
is called plantar fasciitis. It is common among athletes who
run and jump a lot, and can be quite painful.

The condition occurs when the plantar fascia is strained
over time beyond its normal extension, causing the soft
tissue fibers of the fascia to tear or stretch at points
along its length; this leads to inflammation, pain, and
possibly the growth of a bone spur where it attaches to the
heel bone.

The inflammation may be aggravated by shoes that lack
appropriate support, especially in the arch area, and by the
chronic irritation that sometimes accompanies an athletic
lifestyle.

Resting provides only temporary relief. When you resume
walking, particularly after a night's sleep, you may
experience a sudden elongation of the fascia band, which
stretches and pulls on the heel. As you walk, the heel pain
may lessen or even disappear, but that may be just a false
sense of relief. The pain often returns after prolonged rest
or extensive walking.

Excessive Pronation

Heel pain sometimes results from excessive pronation.
Pronation is the normal flexible motion and flattening of the
arch of the foot that allows it to adapt to ground surfaces
and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the
weight shifts first to the outside of the foot, then moves
toward the big toe. The arch rises, the foot generally rolls
upward and outward, becoming rigid and stable in order to
lift the body and move it forward. Excessive
pronation—excessive inward motion—can create an abnormal
amount of stretching and pulling on the ligaments and tendons
attaching to the bottom back of the heel bone. Excessive
pronation may also contribute to injury to the hip, knee, and
lower back.

Disease and Heel Pain

Some general health conditions can also bring about heel
pain.

Rheumatoid arthritis and other forms of arthritis,
including gout, which usually manifests itself in the big
toe joint, can cause heel discomfort in some cases.

Heel pain may also be the result of an inflamed bursa
(bursitis), a small, irritated sack of fluid; a neuroma (a
nerve growth); or other soft-tissue growth. Such heel pain
may be associated with a heel spur, or may mimic the pain of
a heel spur.

Haglund's deformity ("pump bump") is a bone enlargement
at the back of the heel bone, in the area where the Achilles
tendon attaches to the bone. This sometimes painful
deformity generally is the result of bursitis caused by
pressure against the shoe, and can be aggravated by the
height or stitchng of a heel counter of a particular
shoe.

Pain at the back of the heel is associated with
inflammation of the achilles tendon as it runs behind the
ankle and inserts on the back surface of the heel bone. The
inflammation is called achilles tendonitis. It is common
among people who run and walk a lot and have tight tendons.
The condition occurs when the tendon is strained over time,
causing the fibers to tear or stretch along its length, or
at its insertion on to the heel bone. This leads to
inflammation, pain, and the possible growth of a bone spur
on the back of the heel bone. The inflammation is aggravated
by the chronic irritation that sometimes accompanies an
active lifestyle and certain activities that strain an
already tight tendon.

Bone bruises are common heel injuries. A bone bruise or
contusion is an inflammation of the tissues that cover the
heel bone. A bone bruise is a sharply painful injury caused
by the direct impact of a hard object or surface on the
foot.

Stress fractures of the heel bone also can occur, but
these are less frequent.

Children’s Heel Pain

Heel pain can also occur in children, most commonly
between ages 8 and 13, as they become increasingly active in
sports activity in and out of school. This physical activity,
particularly jumping, inflames the growth centers of the
heels; the more active the child, the more likely the
condition will occur. When the bones mature, the problems
disappear and are not likely to recur. If heel pain occurs in
this age group, podiatric care is necessary to protect the
growing bone and to provide pain relief. Other good news is
that heel spurs do not often develop in children.

Prevention

A variety of steps can be taken to avoid heel pain and
accompanying afflictions:

Prepare properly before exercising. Warm up and do
stretching exercises before and after running.

Pace yourself when you participate in athletic
activities.

Don’t underestimate your body's need for rest and good
nutrition.

If obese, lose weight.

Podiatric Medical Care

If pain and other symptoms of inflammation—redness,
swelling, heat—persist, you should limit normal daily
activities and contact a doctor of podiatric medicine.

The podiatric physician will examine the area and may
perform diagnostic X rays to rule out problems of the
bone.

Early treatment might involve oral or injectable
anti-inflammatory medication, exercise and shoe
recommendations, taping or strapping, or use of shoe inserts
or orthotic devices. Taping or strapping supports the foot,
placing stressed muscles and tendons in a physiologically
restful state. Physical therapy may be used in conjunction
with such treatments.

A functional orthotic device may be prescribed for
correcting biomechanical imbalance, controlling excessive
pronation, and supporting of the ligaments and tendons
attaching to the heel bone. It will effectively treat the
majority of heel and arch pain without the need for
surgery.

Only a relatively few cases of heel pain require more
advanced treatments or surgery. If surgery is necessary, it
may involve the release of the plantar fascia, removal of a
spur, removal of a bursa, or removal of a neuroma or other
soft-tissue growth.

Heel Pain Tips From The APMA

If you have experienced painful heels try wearing your
shoes around your house in the evening. Don't wear slippers,
socks or go barefoot. You may also try gentle calf stretches
for 20 to 30 seconds on each leg. This is best done barefoot,
leaning forward towards a wall with one foot forward and one
foot back.

If the pain persists longer then one month you should
visit a podiatrist for evaluation and treatment. Your feet
should not hurt and it may require professional podiatric
care to help relieve your discomfort.

To avoid heel pain, the APMA recommends the following
tips:

If you have not exercised in a long time, consult your
podiatric physician before starting a new exercise
program.

Begin an exercise program slowly, don't go too far or
too fast.

Purchase and maintain good shoes and replace them
regularly.

Stretch each foot and achilles tendon before and after
exercise.

Avoid uneven walking surfaces or stepping on rocks as
much as possible.

Avoid going barefoot on hard surfaces.

Vary the incline on a treadmill during exercise. Nobody
walks uphill all the time.